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Perfusion: Distributive Shock > Septic Shock - Coggle Diagram
Perfusion: Distributive Shock >
Septic Shock
Pathology
Capillary occlusions form
Inflammatory cascade begins as part of the immune response
Proinflammatory mediators (cytokines, interleukin-1, neutrophiles, monocytes, TNF) are released
Increases capillary permeability as (naughty) neutrophils damage endothelial linings and vasodilation adhesion molecules multiply
Injured endothelium release nitric oxide (another vasodilator)
Blood volume is displaced (third spacing) from massive vasodilation leading to insufficient perfusion and hypovolemia as those fluids gather in interstitial spaces deplete fluid volume in circulation
Bacteria from the infection release endotoxins, which antibodies bind to - starting the inflammatory cascade as part of the immune response
Infection sets in - often gram (-) like E. coli
Systems fail as they become hypoxic and can't perform aerobic metabolism to perform their cellular duties
Cerebral hypoxia leads to AMS and decreased LOC
Renal hypoxia leads to acid/base (metabolic acidosis)
Tissue hypoxia triggers release of more inflammatory mediators, driving a positive feedback loop spiraling down towards multiple organs system failures and death
Symptoms
Warm, flushed skin
Fever (older pop. may be afebrile)
Hypotension
Tachycardia
Tachypnea
Thrombocytopenia
Decreased urine output (oliguria)
Loss of appetite
AMS
Metabolic acidosis
Risk factors
Invasive devices (CVAD, Foley catheter...)
Wounds and burns
Cancer
Undiagnosed infection
DM
ICU stays
Immunocompromised
Complications
ARDS
Acute kidney injury (and renal failure)
GI bleeding and ulceration
DIC
Multiorgan system failure (bad outcomes, 30-100% mortality)
Death
Diagnostics
CBC
Serum lactate
Blood Cultures
Urinalysis
Coagulation tests (INR aPTT)
Blood glucose
ABG
Treatment
Antibiotics
Mechanical ventilator
Vasopressors
Surgery (removing septic tissue)
Dialysis (for renal failure r/t septic shock)
Fluid resuscitation to compensate for third spacing
Insulin therapy if hyperglycemic from hyper-metabolism r/t septic shock